DESCRIPTION (provided by investigator): This application addresses Challenge Area (01) Behavior, Behavioral Change, and Prevention and Specific Challenge Topic, 01-CA-103, The Role of Health Behaviors in Cancer Prevention. Research shows that telephone quitlines are effective smoking cessation interventions. However, little research has explored promising approaches that could increase quitline use, improve quit rates, and inform resource allocation for quitline services. The proposed study will test three promising enhancements to standard quitline treatments: 1) combination nicotine replacement therapy (versus nicotine patch alone), 2) extended duration of cessation medication delivery (6 weeks versus 2 weeks), and 3) an innovative counseling addition - cognitive medication adherence counseling (CMAC vs. no CMAC) - to optimize adherence to cessation medication. These three enhancements will be studied in a randomized clinical trial using a 2x2x2 fully crossed factorial design that will permit evaluation of the potential benefit of each approach. In addition, the cost-effectiveness of each intervention will be calculated. The study findings will have broad potential application, since all 50 states have smoking cessation quitlines. The results will allow Quitline service providers to improve existing services and thereby enhance quit rates, and will inform state governments and other purchasers of quitline services about the optimal treatment combination to purchase, thus permitting better use of scarce resources. The findings also may be generalizable to other telephone counseling programs (e.g., disease management programs, health behavior coaching programs), expanding their benefits to population health. All states currently provide telephone "quitline" counseling services to help smokers quit smoking. This project is designed to test promising cessation medication and counseling enhancements that can be added to existing quitline services to increase quit rates. This study will identify the type of quitline treatments that produce the largest and most cost-effective increases in smoking cessation success.